1578624839 NPI number — HEALTH FIRST CHIROPRACTIC OF BAXTER

Table of content: (NPI 1578624839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578624839 NPI number — HEALTH FIRST CHIROPRACTIC OF BAXTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH FIRST CHIROPRACTIC OF BAXTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578624839
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14213 GOLF COURSE DRIVE SUITE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAXTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-829-8414
Provider Business Mailing Address Fax Number:
218-828-2005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14213 GOLF COURSE DRIVE SUITE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAXTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-829-8414
Provider Business Practice Location Address Fax Number:
218-828-2005
Provider Enumeration Date:
12/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PROUTY
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
218-829-8414

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 44G66HE . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: CJ6081 . This is a "RR MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".